Brief Review of HIV and Hepatitis C Virus (HCV) Infection (with focus on HCV)
|
|
- Bethany Walton
- 6 years ago
- Views:
Transcription
1 Brief Review of HIV and Hepatitis C Virus (HCV) Infection (with focus on HCV) James Morrill, MD, PhD MGH Charlestown HealthCare Center Massachusetts General Hospital
2 Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.
3 Medical toll of illicit opioid use Acute Illness Overdose Violence / trauma First-initiated substances Intranasal IV Tentative Compulsive Subacute Effects Soft tissue infection Endocarditis Losses / legal issues Source: SAMHSA, National Survey on Drug Use and Health, Chronic Effects Chronic viral hepatitis, liver disease HIV infection Malnutrition Smoking related illnesses Premature CHD, cancer Homelessness
4 HIV (and HCV) outbreak among injection drug users in Indiana 135 cases as of report Investigation triggered by HIV surveillance Injection of oxymorphone Multigenerational use of injection drugs 84.4% (114/135) also diagnosed with new HCV infection
5 HIV and HCV: Quick Comparison Epidemiology Vaccine available? HIV 33 million worldwide 1.2 million in US Up to 25% coinfected w/ HCV Affects 9% of chronic IDUs Mortality decreasing in US (now 12K/yr) Less efficient needle transmission (0.3%) More efficient sexual / perinatal transmission NO HCV 150 million worldwide million in US Affects 60-70% of chronic IDUs Mortality increasing in US (now 15K/yr) More efficient needle transmission (3%) Less efficient sexual / perinatal transmission NO Whom to screen? 1X testing for all adults age Risk factor based: High-risk sexual practices or partner IVDU Other STIs Pregnant women 1X testing for birth cohort Risk factor based: IVDU Transfusion before July, 1992 Chronic hemodialysis Healthcare worker w/ needlestick Workup HIV Ab / p24 Ag immunoassay HIV viral load CD4 lymphocyte count Antiviral resistance testing Assessment for opportunistic infections HCV Ab immunoassay HCV viral load HCV Genotype Hepatic staging Assessment for extrahepatic manifestations
6 HIV and HCV: Quick Comparison Treatment rationale Whom to treat? How to treat? Curative treatment? Long-term challenges HIV Restore / preserve immune function Reduce HIV-related end-organ damage Reduce HIV transmission Any patient, regardless of CD4 count More urgent w/ OI or high risk of Xmission PREP: High risk sexual partner (or drug use?) Four primary med categories: (NRTIs, NNRTIs, PIs, IIs) Recommended treatment: 2-NRTI backbone + NNRTI, PI, or II 1-pill regimens available: (e.g., Atripla, Complera, Stribild) PREP: Truvada = 2-NRTI combo (Emtricitabine + Tenofovir) NO Treatment adherence Surveillance for non-aids morbidity (CV disease, liver disease, renal disease, cancers, osteoporosis, neurocognitive effects, frailty) HCV Prevent HCV-related chronic liver disease Reduce HCV transmission Advanced liver fibrosis Those at high risk of Xmission Three types of DAAs: (PIs, polymerase inhibitors, NS5A inhibitors) Recommended treatment: 2 or 3 DAAs combined, based on genotype Combination products available: (e.g., Harvoni, Viekira pak, Zepatier) YES Treatment uptake (cascade of care) High cost of drug regimens Prevention of reinfection HCC screening (in those with fibrosis)
7 Hepatitis C: Key Facts Hepatitis C Virus Structure RNA virus that infects liver cells, causing inflammation and damage. Most common and most deadly blood-borne infection in the U.S. Electron micrograph (bar = 50 nm) Viral particle layers Mortality due to Hepatitis viruses and HIV Transmitted by direct blood to blood contact primarily needles Other 9%* Past transfusion 3% Occupational 4% Unknown 10% Injecting drug use 57% Sexual 17% Source: Ly et al. (2012) Ann Int Med 156: 271. Source: Centers for Disease Control and Prevention * Includes cases contracted in the hospital or during childbirth
8 Hepatitis C: Key Facts The Baby Boomer Hepatitis C cohort Highest prevalence 3-4% among baby boomers (1945 to 1965 birth cohort) who should now be screened routinely regardless of risk factors New, rising population of infected young adults. Source: Armstrong et al. (2006) Ann Int Med 144: 705. Two Hepatitis C cohorts at MGH Charlestown More than half of patients with Hepatitis C are unaware of their infection Rise of young adults with Hepatitis C in Massachusetts Source: Onofrey et al. (2011) MMWR 60:
9 Why treat Hepatitis C? Natural history of untreated HCV 80% asymptomatic Exposure 2-12 wk incubation period Acute infection Ab + or -, VL +, ALT More common with: Young patients Females Icteric acute infection Viral clearance (15-25%): Ab +, VL -, ALT nl Promoted by: Alcohol use Older age, male gender HBV or HIV infection High BMI, DM, or fatty liver Chronic infection (75-85%) Ab +, VL +, ALT X Cirrhosis (30%/30yrs) Decompensation or Hepatocellular carcinoma (1-4% per year)
10 Why treat Hepatitis C? New infection X New infection X New infection X Chronic infection Ab +, VL +, ALT X X New infection Cirrhosis (30%/30yrs) Decompensation or Hepatocellular carcinoma (1-4% per year)
11 Workup of Hepatitis C 1) Diagnose and characterize infection: Hepatitis C virus (HCV)Antibody HCV RNA (= viral load) HCV genotype (1-6) HCV Fibrosure (Labcorp): Input: Total bilirubin GGT ALT Alpha-2-macroglobulin Haptoglobin Apolipoprotein A-1 Output: Fibrosis score (F0-F4) Necroinflammatory score (A0-A3) 2) Assess for HCV-related liver disease: Physical exam Liver function tests (LFTs), CBC, APRI, AFP HCV Fibrosure Liver ultrasound Fibroscan Liver biopsy
12 Workup of Hepatitis C 3) Assess for HCV-related conditions: HIV, Hepatitis A serologies Hepatitis B surface antigen and core antibody a new mandate in 2016 Cholesterol, blood sugar, BMI Source: Source: Dartmouth medical photo library Extrahepatic manifestations of HCV Cryoglobulinemia (50%) Low platelets (40%) Autoimmune arthritis (25%) Pruritus, porphyria cutanea tarda (20%) Lymphoma (risk increased by 20%) Diabetes
13 History of Hepatitis C Treatment 1990s Interferon-a (IFN) SC + Ribavirin PO Pegylated (PEG-) IFN + Ribavirin 48 wks 10-30% SVR* G1: 48 G2/3: 24 G1: 44% G2/3: 80% 2011 FDA approval of the first direct acting antivirals (DAAs) against Hepatitis C: the protease inhibitors Telaprevir and Boceprevir G1: PEG-IFN + Ribavirin + Telaprevir or Boceprevir) % SVR = Sustained Virologic Response = Negative HCV viral load 24 weeks after treatment = predictor of a CURE. Late 2013 G2/3: PEG-IFN + Ribavirin 24 80% FDA approval of two new direct acting antivirals (DAAs): - Simeprevir (another oral PI) - Sofosbuvir (an oral polymerase inhibitor) Allowing the first all-oral, IFN-free treatment!
14 Source: Garber (2011) Nature Biotechnology 29: 963. Three main types of antivirals as of 2015 Protease inhibitors Suffix: -previr Examples: - Telaprevir (Incivek) - Boceprevir (Victrelis) - Simeprevir (Olysio) Polymerase inhibitors Suffix: -buvir Examples: - Sofosbuvir (Sovaldi) - Dasabuvir (part of Viekira Pak) NS5A inhibitors Suffix: -asvir Examples: - Ledipasvir (part of Harvoni) - Ombitasvir (part of Viekira Pak)
15 Genotype 1 Options Duration SVR for tx naïve pts SVR for tx experienced or cirrhotic pts Cost Side Effects Harvoni (Sofosbuvir / Ledipasvir) 8 wks (no cirrhosis, low VL) 12 wks (high VL) 24 wks (cirrhosis) 98-99% 97% (24 wks) $94,500 (12 wks) Fatigue (18%) Headache (17%) Nausea (9%) Diarrhea (7%) Insomnia (6%) Viekira Pak (Peritaprevir / Ombitasvir / Dasabuvir) + Ribavirin 12 wks (no cirrhosis) 24 wks (cirrhosis) 97% 95% (24 wks) $83,319 (12 wks) Fatigue (34%) Nausea (22%) Pruritus (18%) Insomnia (14%) Asthenia (14%) Zepatier (Elbasvir / Grazoprevir) 12 wks (no cirrhosis) wks (cirrhosis) 92-99% 97% (16 wks) $54,600 (12 wks) Fatigue (11%) Headache (10%) Abdominal pain (2%) Diarrhea (2%) Irritability (1%) Depression (1%)
16 Genotype 1 Options Duration SVR for tx naïve pts SVR for tx experienced or cirrhotic pts Cost Side Effects Simeprevir/ Sofosbuvir 12 wks (no cirrhosis) 24 wks (cirrhosis) 97% 99% (24 wks) $150,000 (12 wks) Headache (17%) Fatigue (16%) Nausea (14%) Rash (12%) Diarrhea (6%) Dizziness (3%) Epclusa (Velpatasvir / Sofosbuvir) 12 wks (no cirrhosis or cirrhosis) 98-99% 99% $74,760 (12 wks) Headache (22%) Fatigue (15%) Nausea (9%) Asthenia (5%) Insomnia (5%) Irritability (5%) Daclatasvir/ Sofosbuvir 12 wks (no cirrhosis) 24 wks, +/- Ribavirin (cirrhosis) 96% % (24 wks) $63,000 (12 wks) Fatigue (14%) Headache (14%) Nausea (8%) Diarrhea (5%)
17 Genotype 2 Options Duration SVR for tx naïve pts SVR for tx experienced or cirrhotic pts Cost Side Effects Epclusa (Velpatasvir / Sofosbuvir) 12 wks (w/ or w/out cirrhosis) 98-99% 99% $74,760 (12 wks) Headache (22%) Fatigue (15%) Nausea (9%) Asthenia (5%) Insomnia (5%) Irritability (5%) Daclatasvir/ Sofosbuvir 12 wks (no cirrhosis) wks (cirrhosis) >95% >95% (24 wks) $63,000 Fatigue (14%) Headache (14%) Nausea (8%) Diarrhea (5%)
18 Genotype 3 Options Duration SVR for tx naïve pts SVR for tx experienced or cirrhotic pts Cost Side Effects Epclusa (Velpatasvir / Sofosbuvir) 12 wks (w/ or w/out cirrhosis) 98% 93% $74,760 (12 wks) Headache (22%) Fatigue (15%) Nausea (9%) Asthenia (5%) Insomnia (5%) Irritability (5%) Daclatasvir/ Sofosbuvir 12 wks (no cirrhosis) 24 wks, +/- Ribavirin (cirrhosis) 97% 85-90% (24 wks) $63,000 (12 wks) Fatigue (14%) Headache (14%) Nausea (8%) Diarrhea (5%)
19 THANK YOU!! Questions?
Hepatitis C in Correctional Facilities: Big Problem, Bigger Opportunity. Cody A. Chastain, MD
Hepatitis C in Correctional Facilities: Big Problem, Bigger Opportunity Cody A. Chastain, MD Disclosures Research supported by Gilead Sciences Inc.: Site investigator for HIV/HCV SWITCH Registry Study
More informationHCV Treatment in 2016: Genotypes 1, 2, and 3. Cody A. Chastain, MD October 12, 2016
HCV Treatment in 2016: Genotypes 1, 2, and 3 Cody A. Chastain, MD October 12, 2016 Disclosures I have no financial disclosures. Caveats I will only discuss treatment of GT 1-3. Majority of US population
More informationSelecting HCV Treatment
Selecting HCV Treatment Caveats Focus on treatment selection for genotypes 1, 2, and 3. Majority of US population infected with GT 1, 2, or 3 GT 4 treatment closely reflects GT 1 treatment GT 5 and 6 are
More informationNew York State HCV Provider Webinar Series. Side Effects of Therapy
New York State HCV Provider Webinar Series Side Effects of Therapy Objectives Understand the basics of HCV therapy Review the currently available regimens for treatment of HCV Appreciate side effects related
More informationHepatitis C in Disclosures
Hepatitis C in 2018 Sandeep Mukherjee, MD CHI Health and Creighton University Medical Center Division of Gastroenterology Grant support: Abbvie Disclosures Speaker: Abbvie, Gilead, Merck Section editor
More informationHepatitis C Management and Treatment
Hepatitis C Management and Treatment Kaya Süer Near East University Faculty of Medicine Infectious Diseases and Clinical Microbiology 1 Discovery of Hepatitis C Key facts Hepatitis C: the virus can cause
More informationPrimary Care Approach to Diagnosis and Management of Chronic Hepatitis C Brian Viviano, D.O.
Primary Care Approach to Diagnosis and Management of Chronic Hepatitis C Brian Viviano, D.O. Objectives Epidemiology of chronic hepatitis C CDC guidelines on screening or hepatitis C Diagnosing hepatitis
More informationHepatitis C Infection: Updated Information for Front Line Workers in Primary Care Settings MAMTA K. JAIN, MD, MPH 2/14/18
Hepatitis C Infection: Updated Information for Front Line Workers in Primary Care Settings MAMTA K. JAIN, MD, MPH 2/14/18 Overview Hepatitis C Virus Prevalence Effects of Hepatitis C Prevention Diagnosis
More information1/16/2019. Goals of HCV Therapy. Objectives. Treating Hepatitis C and HIV Co Infection. Cure Defined as sustained virologic response (SVR)
HCV ECHO WESTERN STATES HCV ECHO WESTERN STATES Treating Hepatitis C and HIV Co Infection Paulina Deming, Pharm D Associate Professor, College of Pharmacy Assistant Director, Viral Hepatitis Programs,
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Hepatitis C First Generation Agents Page 1 of 16 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C First Generation Agents - Through Preferred
More informationHIV/HCV Coinfection: Why It Matters and What To Do About It. Cody A. Chastain, MD 10/26/16
HIV/HCV Coinfection: Why It Matters and What To Do About It Cody A. Chastain, MD 10/26/16 Disclosures I have no relevant financial disclosures. Objectives At the end of this lecture, the learner will be
More informationMonitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy
Monitoring Patients Who Are Starting HCV Treatment, Are On Treatment, Or Have Completed Therapy WV ECHO August 10, 2017 Selection of patients for HCV treatment Despite current guidance to treat everyone,
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Hepatitis C Second Generation Antivirals Page 1 of 30 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C Second Generation Antivirals Through
More informationHepatitis C Medications Prior Authorization Criteria
Hepatitis C Medications Authorization Criteria Epclusa (/velpatasvir), Harvoni (ledipasvir/), Sovaldi (), Daklinza (daclatasvir), Zepatier (elbasvir/grazoprevir), Olysio (simeprevir), Viekira Pak (ombitasvir/paritaprevir/ritonavir;
More informationHepatitis C Virus (HCV) & Infectious Disease 101 for Hubs & Spokes April 24, :00 pm 1:00 pm
Hepatitis C Virus (HCV) & Infectious Disease 101 for Hubs & Spokes April 24, 2018 12:00 pm 1:00 pm Presenters: Thomas E. Freese, PhD, Larissa Mooney, MD, & Rachel McLean, MPH, Chief, Office of Viral Hepatitis
More informationManagement of Chronic HCV 2017 and Beyond
Management of Chronic HCV 2017 and Beyond Blaire E Burman, MD Virginia Mason Gastroenterology & Hepatology Relevant Disclosures No financial disclosures to report Leaning Objectives Burden of HCV Prevalence
More informationArvind R. Murali, MD Assistant Professor of Medicine Gastroenterology & Hepatology Organ Transplant Center UIHC, Carver College of Medicine
Arvind R. Murali, MD Assistant Professor of Medicine Gastroenterology & Hepatology Organ Transplant Center UIHC, Carver College of Medicine No financial disclosures No conflicts of interest No affiliations
More informationHEPATITIS C. Whitney Dickson, PharmD, BCPS October 12 th, 2017
HEPATITIS C Whitney Dickson, PharmD, BCPS October 12 th, 2017 MY BACKGROUND Pharmacy School: University of California San Diego Pharmacy Practice Residency (PGY1): University of Illinois at Chicago HIV/Hep
More informationPHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline
PHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline Preferred Regimen Based on Diagnosis: Mavyret (glecaprevir/pibrentasvir ) Non-Preferred: Daklinza (daclatasvir) Epclusa (sofosbuvir/velpatasvir)
More informationHepatits C Criteria Direct Acting Antiviral Medications
Hepatits C Criteria Direct Acting Antiviral Medications Harvoni-Formulary PA required 1. Is the patient being treated for a funded condition by the Oregon Health Plan? 2. Does the member have a diagnosis
More informationHEPATITIS C UPDATES. Sanaa S. Said 10 th April, 2014
HEPATITIS C UPDATES Sanaa S. Said 10 th April, 2014 CONTENTS Introduction Epidemiology Transmission and Natural history Kenyan guidelines What is new? References INTRODUCTION Hepacivirus genus, Flaviviridae
More informationACTIVITY DISCLAIMER. Kurt Cook, MD, MSc DISCLOSURE. Audience Engagement System. Learning Objectives
On the Liver Disease Front Lines: Hepatitis A, B and C Prevention and Treatment Kurt Cook, MD, MSc ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family
More information2017 Bruce Lucas Hepatology and Liver Transplant Symposium October 13th 2017 Management of Hepatitis C in Pre- and Post-Transplant Patients
2017 Bruce Lucas Hepatology and Liver Transplant Symposium October 13th 2017 Management of Hepatitis C in Pre- and Post-Transplant Patients Jens Rosenau, MD Associate Professor of Medicine Acting Director
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Hepatitis C First Generation Agents Page 1 of 18 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C First Generation Agents - Through Preferred
More informationPHARMACY PRIOR AUTHORIZATION Hepatitis C Clinical Guideline
Preferred Regimen Based on Diagnosis: Mavyret (glecaprevir/pibrentasvir) PHARMACY PRI AUTHIZATION Hepatitis C Clinical Guideline Non-Preferred: Daklinza (daclatasvir) Epclusa (sofosbuvir/velpatasvir) Harvoni
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Hepatitis C Second Generation Antivirals Page 1 of 32 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Hepatitis C Second Generation Antivirals Through
More informationHEPATITIS C: UPDATE AND MANAGEMENT
HEPATITIS C: UPDATE AND MANAGEMENT José Franco, MD Professor of Medicine Associate Dean for Educational Improvement Associate Director, Kern Institute STAR Center Director José Franco, MD Disclosures I
More informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Harvoni Page: 1 of 7 Last Review Date: June 19, 2015 Harvoni Description Harvoni (ledipasvir &
More information4/30/2015. Interactive Case-Based Presentations and Audience Discussion. Debika Bhattacharya, MD, MSc. Learning Objectives
4/3/215 Interactive Case-Based Presentations and Audience Discussion Debika Bhattacharya, MD, MSc Assistant Clinical Professor University of California Los Angeles Los Angeles, California Formatted:4-27-215
More informationClinical Policy: Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) Reference Number: GA.PMN.25 Product: Medicaid Effective Date: 9/17
Clinical Policy: Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) Reference Number: GA.PMN.25 Product: Medicaid Effective Date: 9/17 Last Review Date: 9/17 Revision Log See Important Reminder at the end of
More informationUpdates in the Treatment of Hepatitis C
Disclosures Updates in the Treatment of Hepatitis C Arslan Kahloon M.D Assistant Professor of Medicine University of Tennessee, Chattanooga I have no conflicts of interest or financial sponsorship to disclose
More informationHepatitis C Medications Hawaii PRIOR AUTHORIZATION REQUEST FORM
Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826. This form contains multiple pages. Please complete all pages to avoid a delay in our decision.
More informationMeet the Professor: HIV/HCV Coinfection
Meet the Professor: HIV/HCV Coinfection Vincent Lo Re, MD, MSCE Assistant Professor of Medicine and Epidemiology Division of Infectious Diseases Center for Clinical Epidemiology and Biostatistics University
More informationLength of Authorization: 8-12 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the medical evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure
More informationHepatitis C: the 2015 Perspective for the Family Medicine Practitioner
Hepatitis C: the 2015 Perspective for the Family Medicine Practitioner Annie Luetkemeyer, MD Division of HIV,ID & Global Medicine San Francisco General Hospital Disclosures I have received research grant
More informationManaging New Treatments for Hepatitis C in Primary Care
Managing New Treatments for Hepatitis C in Primary Care Christina Connel, PharmD, BCPS, AAHIVP Objectives 2 Review HCV disease burden Identify risk factors and recommended testing for HCV Describe who
More informationClinical Policy: Glecaprevir/Pibrentasvir (Mavyret) Reference Number: CP.PHAR.348 Effective Date: 09/17
Clinical Policy: (Mavyret) Reference Number: CP.PHAR.348 Effective Date: 09/17 Last Review Date: 09/17 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationClinical Policy: Glecaprevir/Pibrentasvir (Mavyret) Reference Number: GA.PMN.24 Product: Medicaid Effective Date: 9/17
Clinical Policy: Glecaprevir/Pibrentasvir (Mavyret) Reference Number: GA.PMN.24 Product: Medicaid Effective Date: 9/17 Last Review Date: 9/17 Revision Log See Important Reminder at the end of this policy
More informationHepatitis C Update on New Treatments
Hepatitis C Update on New Treatments Kevork M. Peltekian, MD, FRCPC 44th Annual Dalhousie Spring Refresher Course - Therapeutics April 5 - April 7, 2018 Halifax Convention Centre Disclosures Conflicts
More informationHepatitis C Direct-Acting Antivirals
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the medical evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure
More informationTransmission of HCV in the United States (CDC estimate)
Transmission of HCV in the United States (CDC estimate) Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong
More informationHepatitis C Update: Screening, Diagnosis, and Treatment
Mountain West AIDS Education and Training Center Hepatitis C Update: Screening, Diagnosis, and Treatment Brian R. Wood, MD (bwood2@uw.edu) Assistant Professor of Medicine, University of Washington Medical
More informationREQUEST FOR PRIOR AUTHORIZATION Hepatitis C Treatments
Fax completed form to: 866-940-7328 Prior Authorization Phone Number: 800-310-6826 IA Medicaid Member ID # Patient name Date of Birth Patient address Patient phone Provider NPI Prescriber name Phone Prescriber
More informationClinical Policy: Daclatasvir (Daklinza) Reference Number: ERX.SPMN.180
Clinical Policy: (Daklinza) Reference Number: ERX.SPMN.180 Effective Date: 10/16 Last Review Date: 09/16 Coding Implications Revision Log See Important Reminder at the end of this policy for important
More informationNational Clinical Guidelines for the treatment of HCV in adults. Version 3
National Clinical Guidelines for the treatment of HCV in adults Version 3 January 2017 Sponsors and Authorship The guidelines have been authored on behalf of the viral hepatitis clinical leads and MCN
More informationCommonly Asked Questions About Chronic Hepatitis C
Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral
More informationVosevi (sofosbuvir/velpatasvir/voxilaprevir)
Vosevi (sofosbuvir/velpatasvir/voxilaprevir) Policy Number: 5.01.646 Last Review: 10/2017 Origination: 10/2017 Next Review: 11/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide
More informationCriteria for Indiana Medicaid Hepatitis C Agents
Prepared for State of Indiana by OptumRx EXECUTIVE SUMMARY Purpose: Promote prudent prescribing of Setting & Population: All members Type of Criteria: Increased Risk of ADE Non-Preferred Agent Appropriate
More informationNew Antivirals for Hep C in Context of HIV: Vosevi and Mavyret
New Antivirals for Hep C in Context of HIV: Vosevi and Mavyret John Scott, MD, MSc, FIDSA November 16, 2017 This presentation is intended for educational use only and does not in any way constitute medical
More informationSASKATCHEWAN FORMULARY BULLETIN Update to the 62nd Edition of the Saskatchewan Formulary
April 1, 2017 Bulletin #165 ISSN 1923-0761 SASKATCHEWAN FORMULARY BULLETIN Update to the 62nd Edition of the Saskatchewan Formulary Related Information for Prescribers: Only prescribers who have completed
More informationHepatitis C Agents
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.41 Subject: Hepatitis C Agents Page: 1 of 20 Last Review Date: March 16, 2018 Hepatitis C Agents Description
More informationNew York State HCV Provider Webinar Series
New York State HCV Provider Webinar Series Treatment of HCV/HIV Co-Infection Dost Sarpel, MD Division of Infectious Disease Viral Hepatology Milford Regional Medical Center Objectives Review the epidemiology
More informationHepatitis C Agents
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.41 Subject: Hepatitis C Agents Page: 1 of 19 Last Review Date: December 8, 2017 Hepatitis C Agents
More informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.32 Subject: Harvoni Page: 1 of 9 Last Review Date: March 18, 2016 Harvoni Description Harvoni (ledipasvir
More informationObjectives. Objectives. Introduction. Hepatitis A. Hepatitis B. At the end of the presentation, pharmacy technician participants will be able to:
Objectives A Revolution in Medicine: Advances in the Treatment of Hepatitis C Infection Spencer H. Durham, Pharm.D., BCPS (AQ ID) Assistant Clinical Professor of Pharmacy Practice Auburn University Harrison
More informationHCV in 2017: New Therapies and New Opportunities. Presentation prepared by: Date prepared: OBJECTIVES
Project ECHO HCV Collaborative HCV in 217: New Therapies and New Opportunities Paulina Deming, PharmD Assistant Director Hepatitis C Programs, ECHO Institute Associate Professor College of Pharmacy University
More informationTreatment of Hepatitis C with simeprevir (Olysio ) PLUS sofosbuvir (Sovaldi ) Archived Medical Policy
Treatment of Hepatitis C with simeprevir (Olysio ) PLUS sofosbuvir (Sovaldi ) Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana,
More informationPharmacy Coverage Guidelines are subject to change as new information becomes available.
DIRECT ACTING ANTIVIRAL AGENTS FOR HEPATITIS C VIRUS (HCV): DAKLINZA (daclatasvir) oral tablet EPCLUSA (velpatasvir, sofosbuvir) oral tablet HARVONI (ledipasvir, sofosbuvir) oral tablet MAVYRET (glecaprevir,
More informationOutline. Updates in the Clinical Management of Hepatitis B and C. Who should be screened for HBV? Chronic Hepatitis B 10/7/2018
Outline Updates in the Clinical Management of Hepatitis B and C Jennifer C. Lai, MD, MBA Transplant Hepatologist Associate Professor of Medicine In Residence University of California, San Francisco Initial
More informationSOFOSBUVIR/VELPATASVIR Generic Brand HICL GCN Exception/Other SOFOSBUVIR/ VELPATASVIR
Generic Brand HICL GCN Exception/Other SOFOSBUVIR/ VELPATASVIR EPCLUSA 43561 GUIDELINES FOR USE 1. Is the patient at least 18 years old? If yes, continue to #2. 2. Does the patient have a diagnosis of
More informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.32 Subject: Harvoni Page: 1 of 9 Last Review Date: December 2, 2016 Harvoni Description Harvoni (ledipasvir
More informationPharmacy Medical Necessity Guidelines: Hepatitis C Virus
Pharmacy Medical Necessity Guidelines: Hepatitis C Virus Effective: January 1, 2018 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX)
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Daklinza) Reference Number: HIM.PA.SP27 Effective Date: Last Review Date: 01/17 Line of Business: Health Insurance Marketplace Coding Implications Revision Log See Important Reminder
More informationHarvoni. Harvoni (ledipasvir & sofosbuvir) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.03.32 Subject: Harvoni Page: 1 of 7 Last Review Date: December 3, 2015 Harvoni Description Harvoni (ledipasvir
More informationNational Clinical Guidelines for the treatment of HCV in adults. Version 4
National Clinical Guidelines for the treatment of HCV in adults Version 4 November 2017 Sponsors and Authorship The guidelines have been authored on behalf of the viral hepatitis clinical leads and MCN
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the medical evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure
More informationOutline. HCV Disease Outcomes in the US. Hepatitis C: The New Landscape 5/24/16. Advances in Internal Medicine May 24, I have no disclosures
5/24/16 Hepatitis C: The New Landscape Advances in Internal Medicine May 24, 2016 I have no disclosures Rena K. Fo, MD Professor of Clinical Medicine, UCSF Outline I. Current HCV outcomes in the US II.
More informationHepatitis C Genotypes
9/2/21 OBJECTIVES Project ECHO HCV Collaborative HCV in 21: New Therapies and New Opportunities Paulina Deming, PharmD Assistant Director Hepatitis C Programs, ECHO Institute Associate Professor College
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Mavyret) Reference Number: CP.HNMC.39 Effective Date: 08.15.17 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder at the end of this policy
More informationIt is the policy of health plans affiliated with Centene Corporation that Mavyret is medically necessary when the following criteria are met:
Clinical Policy: (Mavyret) Reference Number: CP.CPA.285 Effective Date: 08.15.17 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important
More informationWHEN HCV TREATMENT IS DEFERRED WV HEPC ECHO PROJECT
WHEN HCV TREATMENT IS DEFERRED WV HEPC ECHO PROJECT October 13, 2016 Reminder - treatment is recommended for all patients with chronic HCV infection Except short life expectancies that cannot be remediated
More informationHepatitis C Virus Clinical Criteria Update September 18, For: New York State Medicaid
Hepatitis C Virus Clinical Criteria Update September 18, 2014 For: New York State Medicaid 1 Purpose Characterize the place in therapy for the agents utilized for management of chronic hepatitis C (CHC)
More informationHepatitis C (Direct Acting Antiviral Medications for Treatment of Hepatitis C) Fibrosis Score Requirement QUEST Integration
Hepatitis C (Direct Acting Antiviral Medications for Treatment of Hepatitis C) Fibrosis Score Requirement QUEST Integration Policy Number: Original Effective Date: MM.04.036 06/01/2015 Lines of Business:
More informationHepatitis C: Module Options for genotype 1a and 1b pros and cons
Drug Regimen HCV genotype Pros Cons Sofosbuvir 400mg + ledipasvir 90mg, orally, Sofosbuvir 400mg, orally, + daclatasvir 60mg, orally Elbasvir 50mg + grazoprevir 100mg, orally Once- single pill regimen.
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Viekira XR, Viekira Pak) Reference Number: ERX.SPA.129 Effective Date: 10.01.16 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important
More informationHepatitis C Introduction and Overview
Hepatitis C Introduction and Overview Michael S. Saag, MD Professor of Medicine Associate Dean of Global Health Director, Center for AIDS Research University of Alabama at Birmingham Birmingham, Alabama
More informationClinical Policy: Elbasvir/grazoprevir (Zepatier) Reference Number: ERX.SPMN.181
Clinical Policy: (Zepatier) Reference Number: ERX.SPMN.181 Effective Date: 10/16 Last Review Date: 09/16 Coding Implications Revision Log See Important Reminder at the end of this policy for important
More informationDrug Class Monograph
Drug Class Monograph Class: Chronic Hepatitis C Drugs(s): Daclatasvir (Daklinza), Dasabuvir/ombitasivir/paritaprevir/ritonavir (Viekira Pak), Elbasvir/grazoprevir (Zepatier), Peginterferon alfa-2a (Pegasys),
More informationClinical Policy: Dasabuvir/ombitasvir/paritaprevir/ritonavir (Viekira XR, Viekira Pak) Reference Number: ERX.SPMN.178
Clinical Policy: (Viekira XR, Viekira Pak) Reference Number: ERX.SPMN.178 Effective Date: 10/16 Last Review Date: 09/16 Coding Implications Revision Log See Important Reminder at the end of this policy
More informationHepatitis C Update: A Growing Challenge With Evolving Management Solutions
Pts (%) Hepatitis C Update: A Growing Challenge With Evolving Management Solutions A Growing Challenge With Evolving Management Solutions Introduction Magda Houlberg, MD Chief Clinical Officer Howard Brown
More informationTreatment of Hepatitis C with sofosbuvir/ledipasvir (Harvoni )
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationManagement of Hepatitis C in Primary Care BABAFEMI ONABANJO, MD & BEN ALFRED, FNP UMASS FAMILY HEALTH CENTER WORCESTER
Management of Hepatitis C in Primary Care BABAFEMI ONABANJO, MD & BEN ALFRED, FNP UMASS FAMILY HEALTH CENTER WORCESTER Objective Epidemiology Screening criteria Appropriate work up Treatment Guidelines
More informationHepatitis C Prior Authorization Policy
Hepatitis C Prior Authorization Policy Line of Business: Medi-Cal P&T Approval Date: November 15, 2017 Effective Date: January 1, 2018 This policy has been developed through review of medical literature,
More informationHepatitis C. No disclosures. 1. The USPSTF recommends Hepatitis C screening in which patient populations?
Hepatitis C Jennifer Acosta PA-C No disclosures 1. The USPSTF recommends Hepatitis C screening in which patient populations? a. All adults at least once b. Immigrants to the US and those over age 65 c.
More informationDisclosures. Outline Update on HCV management & treatment in Primary care. What role does the Family Practice Provider play in HCV care in 2014?
Disclosures 2014 Update on HCV management & treatment in Primary care Annie Luetkemeyer HIV Division San Francisco General Hospital I have received research grant support to UCSF related to HCV from the
More information2017 UnitedHealthcare Services, Inc.
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 1146-7 Program Prior Authorization/Notification Medication Harvoni (ledipasvir/sofosbuvir) P&T Approval Date 10/2014, 2/2015,
More informationLength of Authorization: 8-16 weeks. Requires PA: All direct-acting antivirals for treatment of Hepatitis C. Approval Criteria
Hepatitis C Direct-Acting Antivirals Goals: Approve use of cost-effective treatments supported by the evidence. Provide consistent patient evaluations across all hepatitis C treatments. Ensure appropriate
More informationTreating Hepatitis C-HIV Coinfected Patients Welcome to the Real World
Treating Hepatitis C-HIV Coinfected Patients Welcome to the Real World H. Nina Kim, MD MSc Associate Professor of Medicine University of Washington Division of Allergy & Infectious Diseases April 21, 2017
More informationNew York State HCV Provider Webinar Series. Side Effects of Therapy and Drug-Drug Interactions
New York State HCV Provider Webinar Series Side Effects of Therapy and Drug-Drug Interactions Case Presentation Case 56 year-old lady with Genotype 1A Hepatitis C, Treatment-naive Noninvasive fibrosis
More informationHepatitis C ew Medications, New Hope and New. V. Opportunities for Primary Care. Outline. HCV Disease Outcomes in the US 9/21/2016
Hepatitis C ew Medications, New Hope and New Opportunities for Primary Care Primary Care Principles and Practice October 14, 2016 Disclosures: Grant support Gilead Sciences, Inc Quality improvement Systematized
More informationHepatitis C in Australia:
Hepatitis C in Australia: Epidemiology and Clinical Presentation (and a bit of virology ) A/Prof Mark Douglas Hepatitis C - Distribution Te and Jensen 2010 Clin Liver Dis Hepatitis C Epidemiology Estimated
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Sovaldi) Reference Number: ERX.SPA.127 Effective Date: 10.01.16 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important Reminder at the
More informationChronic Hepatitis C Drug Class Prior Authorization Protocol
Line of Business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 Chronic Hepatitis C Drug Class Prior Authorization Protocol This policy has been developed through review of medical
More informationWhat is Hepatitis C Virus (HCV)?
HEPATITIS C VIRUS (HCV) What is Hepatitis C Virus (HCV)? Hepatitis is an inflammation (swelling or tenderness) of the liver. Hepatitis C virus (HCV) is the most common form of viral hepatitis and usually
More informationClinical Criteria for Hepatitis C (HCV) Therapy
Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C (HCV infection > 6 months), genotype and sub-genotype specified to determine the length of therapy; Liver biopsy
More informationNew Hepatitis C Antivirals
New Hepatitis C Antivirals Kris Stewart, BSP, MD, FRCPC Drug Therapy Conference College of Medicine, University of Saskatchewan September 23, 2016 Disclosures I have received research and program support
More informationConsiderations for the management of Hepatitis C in patients with HIV co-infection
Considerations for the management of Hepatitis C in patients with HIV co-infection Marcella Honkonen, PharmD, BCPS Sunday, February 22, 2012 at 10:15 AM AzPA Southwest Clinical Conference JW Marriott,
More information6/2/2015. Interactive Case-Based Presentations and Audience Discussion
6/2/215 Interactive Case-Based Presentations and Audience Discussion Andrew Aronsohn, MD Assistant Professor of Medicine University of Chicago Medical Center Chicago, Illinois Formatted:5-6-215 Washington,
More informationHCV Disease Outcomes in the US. Hepatitis C New Medications, New Hope and New Opportunities for Primary Care. Learning Objectives 10/13/17
Hepatitis C New Medications, New Hope and New Opportunities for Primary Care Disclosures: Grant for quality improvement Gilead In this talk, 10 drugs will be discussed, 4 of which are manufactured by Gilead.
More informationNational Clinical Guidelines for the treatment of HCV in adults. Version 5
National Clinical Guidelines for the treatment of HCV in adults Version 5 June 2018 Sponsors and Authorship The guidelines have been authored on behalf of the viral hepatitis clinical leads and MCN co-ordinators
More information